Seeley Lake couple welcomes identical triplets

SEELEY LAKE – While Seeley Lake couple Shawn Ellinghouse and Kristy Pohlman had known they were pregnant for over a month, nothing prepared them for the news they received at their first ultrasound May 10.

"When the lady said we were having twins I thought no way. Then when she said it was triplets I was completely stunned," wrote Kristy in an email. "We were not even trying to get pregnant and now we were having not one but three."

Shawn added, "My thoughts to triplets was, WOW! Okay, it is what it is. The man upstairs is not going to give us more than we can handle."

Kristy delivered three identical girls at 28 weeks and three days. While currently still in the NICU, the three girls continue to grow and show their personalities.

Identical triplets are identified in one out of about 60,000 pregnancies. However, according to Kristy's doctor M. Bardett Fausett, MD, Col, USAF (Ret)/ Chairman, Dept of Women's and Newborn Services, Community Medical Center, identical triplets that all survive occur in about one in 200 million pregnancies.

"They are so rare because initially there was one little embryo that split twice. All three portions have to have adequate cellular structure to grow on and develop into a complete human baby," said Fausett.

Fausett said that it is difficult to carry triplets to term for the simple fact that humans typically have only one baby at a time. So, with three babies, the large placenta or placentas and the extra fluid volumes cause extensive stretch on the uterus. This puts a lot of pressure on the cervix and makes the uterus irritable so many women deliver preterm. Others deliver preterm because it is much more likely for women to develop preeclampsia with multiples.

By 26- 28 weeks out of the normal 40, the uterus or womb is typically larger than a large singleton at term.

In Kristy's and Shawn's case, the one egg split between five-eight days after conception to form monochorionic triamniotic triplets. Mononchorionic triamniotic means all three babies shared one placenta but they were each in their own sac, which is a rarity.

At their 13-week appointment, Shawn and Kristy were told the girls would have to be delivered at 32 weeks because her placenta would start to break down. They faced the reality that the girls would be working with the Neonatal Intensive Care Unit (NICU) team at Community Medical Center. 

The delivery date continued to get earlier when the doctors suspected that the girls may have twin-twin transfusion syndrome (TTTS). They were told Kristy could deliver anytime after 24 weeks. 

"These realities definitely change your ideals of bringing the babies home," wrote Kristy. "We went from making a nursery at 10 weeks, to figuring out the best way to accommodate preemies."

TTTS is a rare, serious condition that can occur in pregnancies when multiple babies share a placenta. Abnormal blood vessel connections form in the placenta and allow blood to flow unevenly between the babies.

Fausett further explained that the connections occur between arteries (high pressure) and veins (low pressure) on the surface of the placenta. If one baby's artery is connected to another baby's vein in any sort of an unbalanced way, one baby can act like a donor to its womb mate or womb mates.  This can be life-threatening.

Fausett added that the uterine wall has to be able to provide the blood supply to the placenta.

"This takes a lot of real estate," wrote Fausett in an email. "Sometimes, babies have very different amounts of functioning placenta so one can have poor nutrition compared to others.  Sometimes this makes us deliver them early because a baby is not getting enough nutrients and will die without delivery." 

Shawn and Kristy traveled to Seattle three times during the pregnancy because the girls needed a life saving surgery due to the TTTS. The team in Seattle expected an 85 percent chance of the surgery being successful and all babies making it through. It wasn't until the third trip on July 16 that they were able to separate "Baby C" from "Baby A" and "Baby B."

"These trips made it tough to keep up with our lawn care business.  Thank goodness for understanding clients and amazing friends who stepped up and helped us out!" wrote Kristy. "It also put a strain on my teaching [current third grade teacher at Seeley Lake Elementary], as we were very much up in the air as to if and when I may have to go stay at the hospital until delivery and when I may deliver."

The doctors were able to separate Baby C from the other two, but Baby A and Baby B were still attached. This gave Baby C the boost she needed. While there was a chance they would have to do another surgery to separate Baby A and Baby B if they experienced TTTS, they did not.

"Let's just say it is amazing what they can do on the inside with a half inch incision from the outside and a few needle holes that are not even noticeable!" wrote Kristy on her Facebook page July 17. "We are so grateful to have such amazing teams to be working with!"

Following the TTTS surgery, Kristy was required to take it easy and her activity was restricted to half of normal to allow the amniotic sacs to heal. Unfortunately, the sacs did not cooperate and she continued to leak amniotic fluid.

On July 26 Kristy posted on her Facebook page that the babies' amniotic fluid had evened out, a great indicator that the surgery was a success. The girls were also all pretty close in size and weight.

Kristy was admitted to the hospital Aug. 23 because she was leaking fluid and spotting. While the hope was that it would be for the weekend for monitoring, the duration extended until delivery. Kristy was put on modified bed rest. At just over 24 weeks, they were hoping to delay delivery until at least 28 weeks with the ultimate hope of making it to 32 weeks.

Aug. 31 Kristy posted on her Facebook page, "Only 44 days away from meeting these little girls! They are strong and active, definitely making my insides feel like a jungle gym. They are extremely active after I have eaten and during monitoring times... My favorite part of each day is listening to them while they are on the monitors. It is hilarious how you can almost hear them fighting now. As you hear/feel one kick another one rolls away and then it is almost as if they come back punching. Sure is a blessing!"

By Sept. 10 Kristy had been in the hospital for 19 days. The girls were doing great and the doctors were happy with how stable the girls were. While Baby A was the largest weighing nearly two and half pounds, Baby B and Baby C were close behind weighing almost two pounds each.

As Kristy faced the monotony of waiting in the hospital, she said all of the support she received helped her stay strong. The nurses entertained her with Sudoku, word searches and dot to dots. One even made her girls' onesies. Many visitors stopped in to say "Hi." She graded her third grade students' homework every night and was able to video chat with them. Shawn and her mother Sharon made sure that there was always something to keep her focus. Shawn would video chat with her remotely bringing the outside world, their animals and their home into her room.

Sept. 16 Kristy reached the 28-week mark. This is the point where a baby's lungs are more developed and they have a much better chance of survival without any lasting effects like asthma, vision impairment and heart defects.

"Such a big milestone that the nurses surprised me with a decorated room," wrote Kristy on her Facebook page. "We are so excited to hit this huge milestone! The nurses have challenged me to dance the walk from my room to the operating room, so if any of you have any suggestions on music..."

After not being able to sleep and a lot of discomfort at 4 a.m. Sept. 17, Kristy paged her nurse. She was in labor with contractions two minutes apart. The nurses and doctors did everything they could to stop labor hoping to get a little more time for the girls to develop. Also, Fausett was doing an outreach clinic in Great Falls and Helena and they wanted to get him back for the delivery.

"I am glad that Kristy was able to stay pregnant long enough for me to make it back to participate in the delivery," wrote Fausett. "She would have done well anyway because Dr. Holbrook was available and was taking care of her. It's great to have a such a great partner but I was glad to be able to come back and be a part of it." 

Shawn and Kristy welcomed the girls to the world Thursday, Sept. 19 around 7:21 p.m.

"They arrived strong, crying and ready to take on the world. For being 28 weeks 3 days at birth they have done nothing but continue to show their strength and determination to take life by the horns," wrote Kristy on her Facebook page.

Fausett said while an identical twin pair and a non-identical triplet were born at Community Medical Center a couple of years ago, he believes this is CMC's first set of identical triplets. In his career, he has taken care of three sets of identical triplets - two of which occurred when he was on active duty in Germany.

"Most obstetricians never see that once in their life. So now I guess I am triple cubed lucky!" wrote Faucett. "I am reminded constantly of the sacrifices women are willing to make to keep their children healthy and to have a good outcome. We have really enjoyed taking care of this family! They are wonderful people. We wish them all the best."

After 31 days in the hospital, Kristy was released.

"I tell you I think the hardest part for us was watching the hospital in the rearview mirror," wrote Kristy. "Our girls are in amazing hands with an amazing team supporting them. It is with that knowledge that we tell them goodnight, see you tomorrow!"

Through all the uncertainty, Kristy and Shawn faced each day one step at a time and dealt with challenges as they presented themselves.

"A big shout out to our doctor teams in Seattle and Missoula, Labor and Delivery Nurses, NICU and our families," wrote Kristy. "Shawn and I have grown strong as a unit through all of this.  When you are faced with the realities of losing a child or potentially all three before they are born, it forces you to evaluate your priorities.  As we have trudged our way through this, and now we face the NICU realities, we are definitely a stronger team."